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Little is known about physical activity (PA) and sedentary behavior (SB) among nursing home residents although PA is known as a health promoter. This study examined PA, SB, and their predictors among nursing home residents (n = 63). Dependent variables were accelerometry-based PA and SB. Predictor variables included in a path analysis were age, sex, body mass index, Barthel Index, cognitive status (Mini-Mental State Examination), physical performance (hand grip strength and habitual walking speed), and well-being (World Health Organization-5 well-being index). PA was very low (M steps per day = 2,433) and SB was high (M percentage of sedentary time = 89.4%). PA was significantly predicted by age (β = −0.27, p =.008), body mass index (β = −0.29, p =.002), Barthel Index (β = 0.24, p =.040), and hand grip strength (β = 0.30, p =.048). SB was significantly predicted by body mass index (β = 0.27, p =.008) and Barthel Index (β = −0.30, p =.012). Results might be helpful for everyday practice to identify individuals at high risk for low PA and high SB. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Spinocerebellar ataxia type 3 (SCA3) is an autosomal dominant inherited neurodegenerative disorder for which there is currently no cure, nor effective treatment strategy.Our aim was to investigate the safety and efficacy of high‐dose ganglioside GM1 (ganglioside‐monosialic acid) pulse treatment in patients with SCA3.Patients were randomly allocated to receive either high‐dose GM1 (400 mg on the first day followed by 200 mg/day), low‐dose GM1 (40 mg/day), or placebo (normal saline) for 4 weeks. The primary outcome, assessed by measuring the change in the Scale for the Assessment and Rating of Ataxia (SARA) scores from baseline to 12 weeks post‐treatment, is central to evaluating treatment efficacy. Secondary outcomes included changes in the International Cooperative Ataxia Rating Scale (ICARS) score, Barthel Index of Activities of Daily Living (ADL), and plasma and cerebrospinal fluid (CSF) GABA levels. Safety was assessed in all treated patients.A total of 48 patients with SCA3 were enrolled in this study. After 12 weeks, data from 43 patients were included in the efficacy analysis (intention‐to‐treat analysis). The least‐squares mean change in the SARA score from baseline to 12 weeks post‐treatment was −3.80 (standard error [SE], 0.39; 95% confidence interval [CI], −4.58 to −3.02) in the high‐dose GM1 group, 0.34 (SE, 0.40; 95% CI, −0.46 to 1.13) in the low‐dose GM1 group, and 0.73 (SE, 0.40; 95% CI, −0.07 to 1.52) in the placebo group, respectively. Secondary outcomes showed improvements in the ICARS score, Barthel Index of ADL, and plasma and CSF GABA levels in the high‐dose GM1 group compared to the low‐dose GM1 and placebo groups. All treatments were well‐tolerated and safe.High‐dose GM1 treatment significantly ameliorated ataxic symptoms in patients with SCA3. © 2024 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background: Using Shuxuening injection (SXNI) for acute ischemic stroke (AIS) is popular in China, but its efficacy and safety remain controversial. Purpose: This study aims to assess the efficacy and safety of SXNI as an add-on therapy for AIS. Study design: Systematic review and meta-analysis. Methods: We searched for randomized controlled trials (RCTs) on SXNI for AIS in seven databases and two clinical trial registration platforms from their inception to January 2023. We used the Cochrane risk of bias tool to assess the methodological quality of the included studies and performed the meta-analysis with R software. The primary outcome was clinical efficacy, assessed by the clinical effective rate (CER). The secondary outcomes were neurological function, activities of daily living (ADL), and adverse events (AEs). Results: In total, 116 studies with 12,401 participants were included in this review. Fifteen (12.9%) studies were judged to be of moderate to high quality. SXNI plus conventional treatments (CTs) improved the CER compared with CTs alone (risk ratio [RR]: 1.21, 95% confidence interval [CI]: 1.17–1.25, p < 0.0001) or CTs plus other injections (RR: 1.18, 95% CI: 1.15–1.21, p < 0.0001). SXNI plus CTs reduced the National Institute of Health Stroke Scale score compared with CTs alone (mean difference [MD]: −4.00, 95% CI: −5.22 to −2.78, p < 0.0001) or CTs plus other injections (MD: −2.28, 95% CI: −3.41 to −1.16, p < 0.0001). SXNI plus CTs also decreased the Chinese Stroke Scale score compared with CTs alone (MD: −5.01, 95% CI: −7.38 to −2.65, p < 0.0001) or CTs plus other injections (MD: −4.31, 95% CI: −5.75 to −2.88, p < 0.0001). SXNI plus CTs was superior for increasing the Barthel index score compared with CTs alone (MD: 11.58, 95% CI: 8.27–14.90, p < 0.0001) or CTs plus other injections (MD: 5.43, 95% CI: 0.48–10.39, p = 0.0317). The level of evidence for each outcome was assessed as low to very low. The most common AEs of SXNI were cardiovascular system events, and all these AEs were mild. Conclusion: SXNI combined with CTs maybe better than CTs alone or CTs plus other injections for improving the clinical efficacy, neurological function, and ADL of AIS patients, with relatively reliable safety. However, due to the low quality of the included studies, more rigorously designed RCTs with large sample sizes should be conducted in the future. Systematic Review Registration: www.crd.york.ac.uk, identifier (CRD42023418565). [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of robot-assisted therapy with conventional therapy for accelerating stratified intervention in poststroke patients with upper limb dysfunction. Background: For stroke survivors, recovery of upper extremity function remains a major challenge in rehabilitation. Literature has suggested that the rate of recovery may improve if treatments can be individualized to their clinical profiles. However, there still lack clinical evidence on how to create treatment tailored to individual patients. Robot-assisted Therapy (RT) provides a straightforward approach to adjustment of the assistance-resistance continuum for individual patients. In early Brunnstrom stages of recovery, patients benefit from assistance training, whereas in later stages the training is favored with resistance. Therefore, RT may enhance Conventional Therapy (CT) but the use of RT in stratified intervention has not been investigated. This study evaluated the possible benefit of adopting RT following a protocol of upper-limb training, which was stratified with the Brunnstrom stage of each individual. Methods: This study was a single-blinded randomized controlled trial. A total of 53 patients with stroke were recruited and randomized into 2 groups (CT, n = 27, 3 dropped out and RT, n = 26, 2 dropped out). Both groups were trained once per day, 5 days per week for 4 weeks. The CT group received 30 min of conventional therapy; the RT group received 30 min of upper limb robot-assisted training. Patients were assessed at the beginning, week-2, and week-4 of the treatment. The outcome measures included the Fugl-Meyer Assessment Upper-Extremity (FMA-UE) and the Modified Barthel Index (MBI). Results: Across the 4-week intervention, participants in the RT group recovered 1.979 points of FMA-UE per week, compared to 1.198 points per week in the CT group (t94 = 3.333, p < 0.01); the recovery rate was 0.781 points/week higher in the RT group than in the CT group. Moreover, the recovery of FMA-UE was faster in proximal joints (t94 = 3.199, p < 0.01), and for patients in Brunnstrom Stage III (t34 = 2.526, p < 0.05). The improvements in MBI were not significantly different between RT and CT. Conclusion: Robot-assisted therapy showed initial evidence for the acceleration of post-stroke recovery of motor function in the upper limb. Initial observations suggested that patients in Brunnstrom recovery stage III might benefit the most from the stratified intervention assisted by robotics. Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=61834, Identifier [ChiCTR2000039010]. Registered 13 March 2020. [ABSTRACT FROM AUTHOR]

A health-related (HR) profile is a set of multiple health-related items recording the status of the patient at different follow-up times post-stroke. In order to support clinicians in designing rehabilitation treatment programs, we propose a novel multi-task learning (MTL) strategy for predicting post-stroke patient HR profiles. The HR profile in this study is measured by the Barthel index (BI) assessment or by the EQ-5D-3L questionnaire. Three datasets are used in this work and for each dataset six neural network architectures are developed and tested. Results indicate that an MTL architecture combining a pre-trained network for all tasks with a concatenation strategy conditioned by a task grouping method is a promising approach for predicting the HR profile of a patient with stroke at different phases of the patient journey. These models obtained a mean F1-score of 0.434 (standard deviation 0.022, confidence interval at 95% [0.428, 0.44]) calculated across all the items when predicting BI at 3 months after stroke (MaS), 0.388 (standard deviation 0.029, confidence interval at 95% [0.38, 0.397]) when predicting EQ-5D-3L at 6MaS, and 0.462 (standard deviation 0.029, confidence interval at 95% [0.454, 0.47]) when predicting the EQ-5D-3L at 18MaS. Furthermore, our MTL architecture outperforms the reference single-task learning models and the classic MTL of all tasks in 8 out of 10 tasks when predicting BI at 3MaS and has better prediction performance than the reference models on all tasks when predicting EQ-5D-3L at 6 and 18MaS. The models we present in this paper are the first models to predict the components of the BI or the EQ-5D-3L, and our results demonstrate the potential benefits of using MTL in a health context to predict patient profiles. [ABSTRACT FROM AUTHOR]

Aims/Introduction: The clinical significance of age‐related biomarkers in patients with diabetes has not been fully elucidated. In this study, we aimed to establish models to predict the progression of aging in patients with diabetes using biomarkers. Materials and Methods: This single‐center, retrospective cohort study included 115 Japanese patients with diabetes aged ≥60 years. Age‐related adverse health outcomes were defined as emergency hospitalization, any increase in the level of nursing care certification, admission to a nursing home or death. The associations of age‐related biomarker levels (adiponectin, growth differentiation factor 15 [GDF15], C‐X‐C motif chemokine ligand 9 and apelin) and clinical indicators with age‐related adverse health outcomes were evaluated. Factors that predominantly influenced the occurrence of age‐related adverse health outcomes were explored using the Cox proportional hazards model. Results: The mean age of the 115 participants was 73 years, 50.6% were men, the mean body mass index and hemoglobin A1c level were 25.3 kg/m2 and 9.79%, respectively. There were 26 age‐related adverse health outcomes during the study period (median 1.93, range 0–4.65 years). In a model combining clinical indicators and biomarkers, including the Barthel Index, GDF15 and adiponectin, the occurrence of age‐related adverse health outcomes was found to be significantly associated with GDF15 and Barthel Index. The group with both GDF15 and adiponectin levels higher than the median proved to be significantly higher than the group with both lower. Conclusions: The measurement of GDF15 and adiponectin levels and the Barthel Index might be useful for predicting age‐related adverse health outcomes in patients with diabetes. [ABSTRACT FROM AUTHOR]

• The study compared six frailty tools in older hypertensive outpatients. • Frailty predicted 1-year functional decline, independently of baseline function and comorbidities. • The CFS (score ≥4) predicted 1-year decline with 91 % negative predictive value. • CFS may help identify non-frail hypertensive patients at low risk of functional decline. Few studies have evaluated frailty in older hypertensive individuals and the most appropriate tools to identify frailty in this population have yet to be identified. This study compared the performance of six frailty instruments in the prediction of 1-year functional decline in older hypertensive outpatients. The HYPERtension and FRAILty in Older Adults (HYPER-FRAIL) longitudinal pilot study involved hypertensive participants ≥75 years from two geriatric outpatient clinics at Careggi Hospital, Florence, Italy, undergoing identification of frailty with four frailty scales (Fried Frailty Phenotype, Frailty Index [FI], Clinical Frailty Scale [CFS], Frailty Postal Score) and two physical performance tests (Short Physical Performance Battery [SPPB] and gait speed). Prediction of 1-year functional decline (i.e. a ≥ 10-point Barthel Index decrease between baseline and follow-up) was examined based on ROC curve analysis and multivariable logistic regression. Among 116 participants, 24 % reported functional decline. In the ROC curve analyses, FI (AUC=0.76), CFS (AUC=0.77), gait speed (AUC=0.73) and the SPPB (AUC=0.77) achieved the best predictive performance, with FI ≥0.21 and CFS ≥4 showing the highest sensitivity (82 %) and negative predictive value (91 %). Frailty identified with FI, CFS or physical performance tests was associated with an increased risk of 1-year functional decline, independently of baseline functional status and comorbidity burden. FI, CFS and physical performance tests showed similar predictive ability for functional decline in hypertensive outpatients. The CFS and gait speed might be more suitable for clinical use and may be useful to identify non-frail individuals at lower risk of functional decline. [ABSTRACT FROM AUTHOR]

Background: Chronic, end-stage renal disease significantly impacts patients' daily activities and sleep quality, particularly those undergoing hemodialysis. However, there is limited research on the extent of these challenges and their correlation with this population. Aim: This study aims to assess the level of activity of daily living and the prevalence of sleep disturbances in patients with end-stage renal disease undergoing hemodialysis. Method: A cross-sectional study involved 130 patients receiving hemodialysis in two public General Hospitals in Greece. The Barthel Index was used to measure daily living activity, while the Athens Insomnia Scale assessed sleep disorders. The data were analyzed using SPSSV25.0. Results: Of the 210 questionnaires, 130 were returned fully completed (response rate 62%). Most of the sample participants suffered from comorbidities (76.9%). The total Barthel Index score showed moderate dependence for patients, significantly related to the years and hours of dialysis (p = 0.007 and p = 0.000, respectively). The total score of the Athens Insomnia Scale was also significantly associated with age (p = 0.029), marital status (p = 0.015) and the years and hours of hemodialysis (p = 0.004 and p = 0.001, respectively). A statistically significant difference was recorded between the daily activity of patients with end-stage renal failure and their sleep quality (p = 0.000) Finally, the physical activity level of the participants was related to the existence of another physical health (p = 0.000) or mental health problem (p = 0.000). Conclusions: Hemodialysis patients with chronic, end-stage renal disease experience significant challenges in maintaining daily activities and are prone to sleep disorders. These findings suggest a need for integrated care strategies that address both physical function and sleep quality to improve the overall well-being of this population. [ABSTRACT FROM AUTHOR]

Background: Disability in activities of daily living (ADL) is a common problem among nursing home residents. The purpose of this research was to evaluate the geriatric syndromes that contribute to disability in nursing home residents.Method: The cross-sectional study included 124 older adults from two nursing homes. ADL disability was assessed with the Barthel Index. The sociodemographic characteristics and geriatric syndromes, including malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were evaluated.Results: The 124 residents had a mean age of 80.12 ± 9.20 years and included 55.67% males. Age, malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were all significantly correlated with the Barthel Index. However, only malnutrition, immobility, and urinary incontinence were found to account for 84.9% of the variance in disability of nursing home residents in regression analysis. These geriatric syndromes are the best predictors of ADL disability in all models (p < .05).Conclusion: This study found that malnutrition, immobility, and urinary incontinence considerably contributed to the disability profile of nursing home residents. Health professionals need to develop multi-dimensional care and prevention strategies, especially for geriatric syndromes such as malnutrition, immobility, and urinary incontinence. [ABSTRACT FROM AUTHOR]

Background: Voxel-mirrored homotopic connectivity (VMHC) is utilized to assess the functional connectivity of neural networks by quantifying the similarity between corresponding regions in the bilateral hemispheres of the brain. The exploration of VMHC abnormalities in basal ganglia ischemic stroke (BGIS) patients across different cerebral hemispheres has been limited. This study seeks to establish a foundation for understanding the functional connectivity status of both brain hemispheres in BGIS patients through the utilization of VMHC analysis utilizing resting-state functional magnetic resonance imaging (rs-fMRI). Methods: This study examined a total of 38 patients with left basal ganglia ischemic stroke (LBGIS), 44 patients with right basal ganglia ischemic stroke (RBGIS), and 41 individuals in a healthy control (HC) group. Rs-fMRI studies were performed on these patients, and the pre-processed rs-fMRI data were analyzed using VMHC method. Subsequently, the VMHC values were compared between three groups using a one-way ANOVA and post hoc analysis. Correlation analysis with clinical scales was also conducted. Results: The results indicated that compared to the HC group, significant differences were detected in postcentral gyrus, extending to precentral gyrus in both BGIS groups. Post hoc analysis showed that in the pairwise ROI-based comparison, individuals with LBGIS and RBGIS exhibited reduced VMHC values compared to HC groups. There was no significant difference between the LBGIS and RBGIS groups. In the LBGIS group, the VMHC value showed a negative correlation with NIHSS and a positive correlation with BI. Conclusion: The analysis of VMHC in rs-fMRI revealed a pattern of brain functional remodeling in patients with unilateral BGIS, marked by reduced synchronization and coordination between hemispheres. This may contribute to the understanding of the neurological mechanisms underlying motor dysfunction in these patients. [ABSTRACT FROM AUTHOR]

Background: Stroke is a serious health issue that affects individuals, families, and society. Particularly, the upper limb dysfunction caused by stroke significantly reduces the quality of life for patients and may lead to psychological issues. Current treatment modalities are not fully effective in helping patients regain upper limb motor function to optimal levels. Therefore, there is an urgent need to explore new rehabilitation methods to address this issue. Objective: The purpose of thismeta-analysis and systematic review is to explore the effects of intermittent theta burst stimulation (iTBS) on upper limb function in stroke patients. Methods: We searched PubMed, Cochrane Library, Embase, Web of Science, PEDro and China National Knowledge Internet as of April 8, 2024. Retrieved a total of 100 articles. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated. Results: The study included a total of 9 trials and involved 224 patients. The results demonstrate that compared to the control group, iTBS therapy significantly improved Fugl-Meyer assessment-upper extremity (FMA-UE) scores (SMD = 0.88; 95% CI = 0.11-1.66; P = 0.03, I² = 84%), Action Research Arm Test (ARAT) scores (SMD = 0.83; 95% CI = 0.16-1.50; P = 0.02, I² = 57%), and Barthel Index (BI) scores (SMD = 0.93; 95% CI = 0.53-1.32; P < 0.0001, I2 = 0%) in stroke patients. Conclusions: The comprehensive evidence suggests that iTBS has superior effects in improving upper limb function and activities of daily living in stroke patients. [ABSTRACT FROM AUTHOR]

Good data quality is vital for personalising plans in rehabilitation. Machine learning (ML) improves prognostics but integrating it with Multiple Imputation (MImp) for dealing missingness is an unexplored field. This work aims to provide post-stroke ambulation prognosis, integrating MImp with ML, and identify the prognostic influential factors. Stroke survivors in intensive rehabilitation were enrolled. Data on demographics, events, clinical, physiotherapy, and psycho-social assessment were collected. An independent ambulation at discharge, using the Functional Ambulation Category scale, was the outcome. After handling missingness using MImp, ML models were optimised, cross-validated, and tested. Interpretability techniques analysed predictor contributions. Pre-MImp, the dataset included 54.1% women, 79.2% ischaemic patients, median age 80.0 (interquartile range: 15.0). Post-MImp, 368 non-ambulatory patients on 10 imputed datasets were used for training, 80 for testing. The random forest (the validation best-performing algorithm) obtained 75.5% aggregated balanced accuracy on the test set. The main predictors included modified Barthel index, Fugl-Meyer assessment/motricity index, short physical performance battery, age, Charlson comorbidity index/cumulative illness rating scale, and trunk control test. This is among the first studies applying ML, together with MImp, to predict ambulation recovery in post-stroke rehabilitation. This pipeline reliably exploits the potential of incomplete datasets for healthcare prognosis, identifying relevant predictors. [ABSTRACT FROM AUTHOR]

Introduction: Hip fracture is particularly seen in elderly patients with frailty and osteoporosis and leads to diminished functional independence and quality of life. Despite the susceptibility of these patients to a second hip fracture (SHF), the literature insufficiently discussed its impact leading to poor outcomes. This study aims to directly assess the outcomes of elderly patients with initial hip fractures (IHF) vs those experiencing an SHF within a well-matched group with similar characteristics. Materials and Methods: This case–control study gathered data from the clinical hip fracture registry at a medical center from 2019 to 2022. Patients with SHF were matched with those with IHF in a 1:2 ratio according to the similarity of age, sex, and Charlson Comorbidity Index classification. Demographics at admission, baseline characteristics, and 1-year postoperative outcome were compared between the SHF and IHF groups. Results: Thirty-two SHF patients were matched with 64 IHF patients (81.25% of women, median age of 86 years). Anthropometric measurements and socioeconomic factors were not significantly different between the two groups. No differences in baseline characteristics were observed, except IHF patients had a significantly lower T-score than SHF patients (−3.98 vs. −3.31, P = 0.016). At one-year follow-up, despite a notable decrease in Barthel Index scores and an uptick in EQ-5D measures among the patients, the IHF and SHF groups demonstrated similar quality of life and a high level of activities of daily living. Discussions: In this case-control study, after matching for age, sex, and comorbidities, an SHF did not indicate poorer outcomes than an IHF, providing a more optimistic outlook for the patients and healthcare providers. Conclusion: Despite the significant challenges presented by hip fracture, the one-year postoperative outcomes did not differ between IHF and SHF patients, suggesting that SHF is not an independent predictor of poor outcomes following hip fracture in the elderly population. [ABSTRACT FROM AUTHOR]

The impact of non-motor symptoms is often overlooked in favour of the motor symptoms when managing Parkinson's disease resulting in suboptimal patient outcomes. This study aimed to characterise the non-motor symptoms of Parkinson's disease in a cohort of Sri Lankan patients with a special focus on the impulsive control disorders and other compulsive behaviours (ICDs-CB) that had not been previously studied in this population. All patients with idiopathic Parkinson's disease followed up at the National Hospital of Colombo, Sri Lanka were included. The presence or absence of non-motor symptoms and their perceived impact was recorded with an interviewer administered questionnaire. Symptoms of anxiety and depression were assessed with Hamilton Anxiety and Depression scales. Presence of ICDs-CB was assessed with the questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease. Of 192 patients 97% (186) reported at least 2 non-motor symptoms. About 83% (160/192) screened positive for anxiety, 40% (76/192) for depression, and 17% (32/192) for an ICDs-CB. A lower Barthel index, history of past psychiatric disorders and family history of alcohol abuse were independent predictors of ICDs-DB. Managing both motor and non-motor symptoms are important to preserve the quality of life of patients with Parkinson's disease. They should be screened for symptoms for anxiety and depression regularly during follow up and educated about the possibility of ICDs-CB soon after diagnosis. [ABSTRACT FROM AUTHOR]

Physical functioning can be increased in people with stroke by using a mobile health application. This study aimed to investigate the feasibility of a 10-week community-based program using the WalkWithMe (WWM) application in people with late sub-acute and chronic stroke in Benin. An interventional pilot study with mixed methods research design was used examining the application of an unsupervised individualized mobile Health (mHealth) instructed training program. Main outcome included the application usage, safety, adherence, perceived enjoyment, mHealth quality, patient experiences and pre-post efficacy measures. Nine adults, five males, median age of 60 years and time since stroke of 12 months participated in this study. For most participants adherence with the application was over 70%. However, some usability problems were observed due to incorrect understanding and use by participants and technical problems. The application was very fun, stimulating and enjoyable. Significant improvements were found with median (pre/post measures) of locomotors skill (1.4/3.4); impairments (38/40), Barthel Index (85/95), activity limitation (2.1/3.1), and quality of life (194/218). A trend towards significant improvement was found with 6 minutes walking test (181/220, p = 0.06). The WWM application is perceived as a potential approach to increase physical activity and functioning among people with stroke in Benin. [ABSTRACT FROM AUTHOR]

Background/Objectives: Physical rehabilitation based on neurofunctional exercises can have a positive impact on restoring functionality and enhancing the quality of life of these individuals. Therefore, the purpose of this study is to analyze the effects of rehabilitation, including neurofunctional exercises, on the functional status of stroke patients. Methods: The cohort study design included 102 male and female participants: 51 patients underwent physiotherapy rehabilitation including neurofunctional exercises (SG), while the other 51 did not follow a rehabilitation program based on neurofunctional exercises (CG). The participants were assessed twice: once during their stay in the early neurology department after the first stroke, and again six months later. The assessments were conducted using the Barthel Scale (BS), the Rankin Scale (RS), and the National Institutes of Health Stroke Scale (NIHSS). Results: Baseline comparisons revealed significantly greater BS (p = 0.001) in the CG compared to the SG. Conversely, the SG had a significantly higher NIHSS than the CG at baseline (p = 0.001), as well as higher RS (p < 0.001). Within the SG, there were significant increases in BS (p < 0.001), while no significant differences were found between baseline and post 6 months in RS (p = 0.537) and NIHSS (p = 0.475). Regarding the CG, significant increases were observed in BS (p = 0.005) and NIHSS (p < 0.001), while no significant differences were found in RS (p = 0.335). Conclusions: In conclusion, this study reveals that incorporating neurofunctional exercises does not appear to play a significant role in the patients' progress. The controlled group, engaged in home-based activities, showed greater improvements in their condition. [ABSTRACT FROM AUTHOR]

Background/Objectives: Multiple sclerosis is characterised by the manifestation of heterogeneous symptoms that affect daily functioning. Patients face physical impairment, psychological problems and socioeconomic changes. Depending on the form of the disease, they may have different needs, which are often unsatisfied and could be overcome by including palliative care in the treatment. Despite the above, not enough is known about this population's needs for palliative care. This cross-sectional study aimed to identify the need for palliative care and assess the functional dependence level in daily living activities in patients with multiple sclerosis. Methods: The sample consisted of 120 patients from the Neurology Clinic of the University Clinical Center of Vojvodina, Serbia. The following research instruments were used: a General questionnaire, Sheffield Profile for Assessment and Referral for Care, Multiple Sclerosis Impact Scale and Barthel Index. Results: The need for palliative care was expressed by 36.7% of patients, who expressed the most concern for the physical symptoms, independence and activity domains. Also, it was determined that the disease prevents patients from doing demanding physical tasks and that they are worried about multiple sclerosis. Almost a quarter of patients have had complete/severe dependence on other persons in performing daily activities. Conclusions: The most frequently reported physical symptoms by patients with MS were weakness, bladder problems, fatigue and different levels of dependence, while concerns related to sexual health, low mood and anxiety emerged as key challenges in the psychological domain. These findings underscore the importance of conducting needs assessments to guide the development of an appropriate palliative care model for MS patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of robot-assisted therapy with conventional therapy for accelerating stratified intervention in poststroke patients with upper limb dysfunction. Background: For stroke survivors, recovery of upper extremity function remains a major challenge in rehabilitation. Literature has suggested that the rate of recovery may improve if treatments can be individualized to their clinical profiles. However, there still lack clinical evidence on how to create treatment tailored to individual patients. Robot-assisted Therapy (RT) provides a straightforward approach to adjustment of the assistance-resistance continuum for individual patients. In early Brunnstrom stages of recovery, patients benefit from assistance training, whereas in later stages the training is favored with resistance. Therefore, RT may enhance Conventional Therapy (CT) but the use of RT in stratified intervention has not been investigated. This study evaluated the possible benefit of adopting RT following a protocol of upper-limb training, which was stratified with the Brunnstrom stage of each individual. Methods: This study was a single-blinded randomized controlled trial. A total of 53 patients with stroke were recruited and randomized into 2 groups (CT, n = 27, 3 dropped out and RT, n = 26, 2 dropped out). Both groups were trained once per day, 5 days per week for 4 weeks. The CT group received 30 min of conventional therapy; the RT group received 30 min of upper limb robot-assisted training. Patients were assessed at the beginning, week-2, and week-4 of the treatment. The outcome measures included the Fugl-Meyer Assessment Upper-Extremity (FMA-UE) and the Modified Barthel Index (MBI). Results: Across the 4-week intervention, participants in the RT group recovered 1.979 points of FMA-UE per week, compared to 1.198 points per week in the CT group (t94 = 3.333, p < 0.01); the recovery rate was 0.781 points/week higher in the RT group than in the CT group. Moreover, the recovery of FMA-UE was faster in proximal joints (t94 = 3.199, p < 0.01), and for patients in Brunnstrom Stage III (t34 = 2.526, p < 0.05). The improvements in MBI were not significantly different between RT and CT. Conclusion: Robot-assisted therapy showed initial evidence for the acceleration of post-stroke recovery of motor function in the upper limb. Initial observations suggested that patients in Brunnstrom recovery stage III might benefit the most from the stratified intervention assisted by robotics. [ABSTRACT FROM AUTHOR]

A health-related (HR) profile is a set of multiple health-related items recording the status of the patient at different follow-up times post-stroke. In order to support clinicians in designing rehabilitation treatment programs, we propose a novel multi-task learning (MTL) strategy for predicting post-stroke patient HR profiles. The HR profile in this study is measured by the Barthel index (BI) assessment or by the EQ-5D-3L questionnaire. Three datasets are used in this work and for each dataset six neural network architectures are developed and tested. Results indicate that an MTL architecture combining a pre-trained network for all tasks with a concatenation strategy conditioned by a task grouping method is a promising approach for predicting the HR profile of a patient with stroke at different phases of the patient journey. These models obtained a mean F1-score of 0.434 (standard deviation 0.022, confidence interval at 95% [0.428, 0.44]) calculated across all the items when predicting BI at 3 months after stroke (MaS), 0.388 (standard deviation 0.029, confidence interval at 95% [0.38, 0.397]) when predicting EQ-5D-3L at 6MaS, and 0.462 (standard deviation 0.029, confidence interval at 95% [0.454, 0.47]) when predicting the EQ-5D-3L at 18MaS. Furthermore, our MTL architecture outperforms the reference single-task learning models and the classic MTL of all tasks in 8 out of 10 tasks when predicting BI at 3MaS and has better prediction performance than the reference models on all tasks when predicting EQ-5D-3L at 6 and 18MaS. The models we present in this paper are the first models to predict the components of the BI or the EQ-5D-3L, and our results demonstrate the potential benefits of using MTL in a health context to predict patient profiles. [ABSTRACT FROM AUTHOR]

Background: Stroke-associated pneumonia (SAP) is a common complication in stroke patients, and the Barthel Index (BI) is a well-established metric for assessing activities of daily living (ADL). However, the association between BI and SAP in acute ischemic stroke (AIS) patients remains unclear. This study aims to investigate the relationship between BI at admission and SAP, and explore the factors in AIS elderly patients. Method: Retrospective data were collected from ischemic stroke patients hospitalized at the Second Affiliated Hospital of Nanchang University between January 2018 and July 2021, including their basic demographic and laboratory test results. Restricted cubic spline regression, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were employed to investigate the relationship between BI and SAP. Additionally, the Shapley Additive exPlanations (SHAP) method was used to identify the factors influencing SAP. Results: The study included 7,548 eligible stroke patients with a mean age of 75.1 ± 7.6 years, among which 41.14% were female. The SAP group demonstrated significantly lower BI compared to the non-SAP group (50.86 ± 35.60 vs. 75.27 ± 26.33, P < 0.001). Additionally, a conspicuous trend of decreasing SAP risk across the Q1-4 groups was observed (P < 0.001). The RCS analysis further confirmed a gradual reduction in SAP risk with increasing BI. Based on the clinical model, both the BI (NRI = 0.014, P = 0.005; IDI = 0.04, P < 0.001) and the NIHSS score (NRI = 0.09, P = 0.03; IDI = 0.025, P < 0.001) demonstrated additional predictive value for SAP. Multivariate logistic regression and SHAP analysis identified WBC, CONUT, TG, UA, and RBC levels, as well as the type of health insurance (urban employee basic medical insurance), as important independent predictors of SAP. Conclusion: BI at admission constitutes a risk factor for the onset of SAP in elderly patients with AIS, Compared to the NIHSS and mRS score, BI may be a more reliable and practical predictor of SAP. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have shown that stroke patients exhibit greater neuroimaging-derived biological "brain age" than control subjects. This difference, known as the brain age gap (BAG), is calculated by comparing the chronological age with predicted brain age and is used as an indicator of brain health and aging. However, whether stroke accelerates the process of brain aging in patients with small-volume infarcts has not been established. By utilizing longitudinal data, we aimed to investigate whether small-volume infarctions can significantly increase the BAG, indicating accelerated brain aging. Methods: A total of 123 stroke patients presenting with small-volume infarcts were included in this retrospective study. The brain age model was trained via established protocols within the field of machine learning and the structural features of the brain from our previous study. We used t-tests and regression analyses to assess longitudinal brain age changes after stroke and the associations between brain age, acute stroke severity, and poststroke outcome factors. Results: Significant brain aging occurred between the initial and 6-month follow-ups, with a mean increase in brain age of 1.04 years (t = 3.066, p < 0.05). Patients under 50 years of age experienced less aging after stroke than those over 50 years of age (p = 0.245). Additionally, patients with a National Institute of Health Stroke Scale score >3 at admission presented more pronounced adverse effects on brain aging, even after adjusting for confounders such as chronological age, sex, and total intracranial volume (F1,117 = 7.339, p = 0.008, χ2 = 0.059). There were significant differences in the proportional brain age difference at 6 months among the different functional outcome groups defined by the Barthel Index (F2,118 = 4.637, p = 0.012, χ2 = 0.073). Conclusion: Stroke accelerates the brain aging process, even in patients with relatively small-volume infarcts. This phenomenon is particularly accentuated in elderly patients, and both stroke severity and poststroke functional outcomes are closely associated with accelerated brain aging. Further studies are needed to explore the mechanisms underlying the accelerated brain aging observed in stroke patients, with a particular focus on the structural alterations and plasticity of the brain following minor strokes. [ABSTRACT FROM AUTHOR]

Background: Stroke frequently results in upper limb motor dysfunction, with traditional therapies often failing to yield sufficient improvements. Emerging technologies such as virtual reality (VR) and noninvasive brain stimulation (NIBS) present promising new rehabilitation possibilities. Objectives: This study systematically reviews and meta-analyses the effectiveness of VR and NIBS in improving upper limb motor function in stroke patients. Methods: Registered with PROSPERO (CRD42023494220) and adhering to the PRISMA guidelines, this study conducted a thorough search of databases including PubMed, MEDLINE, PEDro, REHABDATA, EMBASE, Web of Science, Cochrane, CNKI, Wanfang, and VIP from 2000 to December 1, 2023, to identify relevant studies. The inclusion criterion was stroke patients receiving combined VR and NIBS treatment, while exclusion criteria were studies with incomplete articles and data. The risk of bias was assessed using the Cochrane Collaboration tool. Statistical analysis was performed using Stata SE 15.0, employing either a fixed-effects model or a random-effects model based on the level of heterogeneity. Results: A total of 11 studies involving 493 participants were included, showing a significant improvement in Fugl-Meyer Assessment Upper Extremity (FMA-UE) scores in the combined treatment group compared to the control group (SMD = 0.85, 95% CI [0.40, 1.31], p = 0.017). The Modified Ashworth Scale (MAS) scores significantly decreased (SMD = − 0.51, 95% CI [− 0.83, − 0.20], p = 0.032), the Modified Barthel Index (MBI) scores significantly increased (SMD = 0.97, 95% CI [0.76, 1.17], p = 0.004), and the Wolf Motor Function Test (WMFT) scores also significantly increased (SMD = 0.36, 95% CI [0.08, 0.64], p = 0.021). Subgroup analysis indicated that the duration of treatment influenced the outcomes in daily living activities. Conclusions: The combination of VR and NIBS demonstrates significant improvements in upper limb motor function in stroke patients. The duration of treatment plays a critical role in influencing the outcomes, particularly in activities of daily living. This systematic review has limitations, including language bias, unclear randomization descriptions, potential study omissions, and insufficient follow-up periods. Future studies should focus on exploring long-term effects and optimizing treatment duration to maximize the benefits of combined VR and NIBS therapy. [ABSTRACT FROM AUTHOR]

Introduction: Hemineglect is a condition in which patients are unable to report, respond to, or orient themselves to significant stimuli in the opposite side of space after a brain lesion that cannot be attributed to sensory or motor dysfunction. Patient as well as the caregivers is unaware of the poststroke symptoms. Educating both patients and caregivers about hemineglect is crucial for effective management and support. By providing education, patients gain a better understanding on their condition, its impact on daily life and strategies to cope with it. Caregivers on the other hand can learn how to provide appropriate support, create a supportive environment and assist with rehabilitation exercises. Aim: To determine the effect of education on hemineglect in patients with acute stroke. Materials and Methods: This parallel active controlled, randomised controlled trial with 32 participants who were hospitalised in Justice K.S Hegde Hospital, Mangaluru, Karnataka was conducted between January 2023-January 2024. Allocation was done by sequentially numbered opaque and sealed envelope method. The selected participants were randomly divided into Experimental Group-A (16 participants) and Group-B (control-16 participants). Group-A received education on cueing, environmental modification, shifting of representation of space and regarding sensory and perceptual awareness for 15 minutes once a day along with the standard care and control Group-B (16 participant) recieved the standard care only. Both the groups received standard care treatment for 40 minutes one session per day for five days. The Pre-post intervention evaluation was done for both groups using line bisection test, Catherine Bergego scale and Barthel Index. The collected data were summarised by using the descriptive statistics: frequency, percentage; mean and SD. The independent sample t-test was used to compare the effectiveness (Pre-Post) Line Bisection, Catherine Bergego Scale, and Barthel Index between groups. Results: Line bisection test, Catherine Bergego Scale and Barthel Index for the experimental group were 1.19±0.57, 8.13±2.16, -22.19±12.38, respectively and for the control group were 0.06±0.42, 2.50±2.92, -6.88±6.29. The group comparison of Line Bisection Test, Catherine Bergego Scale and Barthel Index were found to be statistically significant (p<0.001). Conclusion: The study concluded that patient and caregiver education coupled with conventional physical therapy is effective in improving the perceptual awareness and reduction in the presence and severity of hemineglect following acute stroke. [ABSTRACT FROM AUTHOR]

Aims and objective: To investigate the impact of acupuncture on post‐stroke cognitive impairment (PSCI). Background: PSCI is a major barrier to stroke patients' rehabilitation, and acupuncture is one of the treatments. However, the benefit of acupuncture on PSCI is unclear. Design: A meta‐analysis and systematic review of randomized controlled trials (RCTs). Methods: Up to February 1, 2024, databases in PubMed, MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched. The risk of bias was investigated using the Cochrane Handbook for systematic reviews of treatments. Random‐effect and fix‐effect models were used to report the effects. Results: There were 29 randomized clinical trials with 2477 participants included. The findings demonstrated that the Mini‐Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scores were higher in the acupuncture group than medicine group (mean difference [MD] = 1.74, 95% confidence interval (CI) CI [1.26, 2.23], I2 = 59%, p < 0.01). Compared to medicine group, the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score exhibited a significant decrease and demonstrated improvement in the acupuncture group. Statistically significant outcomes were observed in the Barthel Index scores and P300 event‐related potential (ERP). According to subgroup analysis, acupuncture was superior to conventional therapy for improving cognitive function in PSCI patients at 4 weeks after treatment. Conclusion: Acupuncture therapy has shown promise in ameliorating cognitive deficits and enhancing daily functional abilities in individuals diagnosed with PSCI. But future research should focus on the duration and implement large sample, high‐quality RCTs. Relevance to clinical practice: Clinical workers in practical clinical work can select appropriate acupoints according to the actual conditions of patients, as well as confirm the treatment course of PSCI patients, while paying attention to observing and evaluating the therapeutic efficacy of acupuncture, to improve the health outcomes of patients in a patient‐centered way. [ABSTRACT FROM AUTHOR]

Background: Few studies explore the patient heterogeneity, trajectory development, and factors influencing the functional recovery of the postacute care cerebrovascular disease (PAC-CVD) program. The objective of the study was to analyze the group-based trajectory and different functional improvement for patients with acute stroke participating in the PAC-CVD program. Materials and Methods: A total of 328 patients with acute stroke who had participated in PAC-CVD program in rehabilitation departments of three hospitals from 2014 to 2017 were enrolled in this retrospective cohort study. Latent profile analysis (LPA) was applied to analyze the clinical characteristics between high- and low-function groups (LFGs). The analysis of variance and Chi-square test were used to analyze the association between functional grouping and patients' characteristics. Results: In the study baseline, patients could be divided into high function group (HFG; 85/328 = 25.9%), medium function group (MFG; 128/328 = 39.02%), and (LFG; 115/328 = 35.06%) by LPA. age (P = 0.001), length of hospital stays (P = 0.001), male sex (P = 0.048), and lesion type (P = 0.023) were significantly associated with being grouped in the high-function group. After 6 weeks of rehabilitation training, 100% of HFG remained as HFG, 49.04% of MFG transitioned to HFG, and 50% of MFG continued to remain as MFG. 8.41% of LFG transitioned to HFG, 57% of LFG transitioned to MFG, but still, 34.58% of LFG continued to remain as LFG. Conclusion: Identifying initial functional groups can guide medical professionals to target patients for PAC service use. PAC-CVD high-intensity rehabilitation significantly enhances acute stroke patients' functional recovery, though effectiveness varies over time. These factors highlight the need for further development of rehabilitation programs to boost patient independence. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical efficacy of butylphthalide in treating patients with stroke attributed to intracranial artery stenosis (ICAS). Methods: In this retrospective study, records of 163 patients with stroke attributed to ICAS admitted to Jiaxing Second Hospital from January 2021 to January 2023 were retrospectively analyzed. Patients were divided into two groups based on the treatment received: control group (patients received routine treatment, n=55) and observation group (patients treated with butylphthalide on a routine basis, n=58). Changes in levels of cerebrovascular reactivity (CVR), breath-holding index (BHI), pulsatility index (PI), and middle cerebral artery mean flow velocity (Vm) between the two groups before and after treatment were compared. In addition, cognitive function, neurological function, and living ability were compared between the two groups before and after treatment, as well as the overall clinical efficacy of the treatment. Results: The baseline data was comparable between the two groups (P>0.05). After the treatment, CVR, BHI, and Vm indicators in the observation group were significantly higher than those in the control group, while the levels of PI indexes were significantly lower than those in the control group (P<0.05). Montreal Cognitive Assessment (MoCA) and Barthel scale scores of the observation group were significantly higher compared to the control group, while the scores of National Institutes of Health Stroke Scale (NIHSS) were significantly lower (P<0.05). Conclusions: Butylphthalide in addition to routine treatment can effectively improve cerebrovascular reserve function, promote neurological and cognitive dysfunction recovery, and enhance daily living ability of patients with stroke caused by ICAS. [ABSTRACT FROM AUTHOR]

Background: Spending time away from bed is important in older adults. Not doing so can lead to functional decline rapidly. Objective: To investigate the association between oral function and time spent away from bed in older adults living in nursing homes. Methods: We enrolled 748 adults aged ≥65 years across eight nursing homes between April 2022 and March 2023. 'Problems with oral hygiene' and 'problems with oral function' were the dependent variables in the multiple regression analyses to determine their association with time spent away from bed. Results: We selected 304 participants (76 men; mean age, 86.3 ± 7.5 years) and divided them into three groups: group S (< 4 h), group M (4 to < 6 h) and group L (≥ 6 h), with 28, 23 and 253 participants, respectively. Comparison of the characteristics between the groups demonstrated significant differences in the Barthel index (p <.001), time spent away from bed (p <.001), history of aspiration pneumonia (p <.001), confirmation of meals and food forms (p =.010), problems with oral hygiene (p =.014), and problems with oral function (p =.002). Based on multiple regression analyses, 'problems with oral hygiene' (p <.001) and 'problems with oral function' (p <.001) were significantly associated with time spent away from bed. Conclusions: The time spent away from bed was significantly associated with both oral hygiene and function in older adults, suggesting the importance of extending the time that older adults spend away from bed. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shockwave therapy (ESWT) has been proven beneficial for post-stroke spasticity (PSS) of ankle plantar flexor muscles. This study aims to investigate the dose-response effectiveness of focused-ESWT and the duration of its effect on the treatment of ankle PSS in stroke patients. Methods: In this double-blinded randomized controlled trial, stroke patients diagnosed with PSS in the ankle plantar flexor muscles were randomly assigned to two groups. The experimental group received double-dose ESWT (4000 pulses per session) targeting spastic calf muscles, while the control group received half the dose (2000 pulses per session). Both groups underwent four sessions over two weeks. The outcomes, including modified Ashworth Scale (MAS), modified Tardieu Scale (MTS), passive range of motion (PROM) of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography were evaluated at baseline, 1st, 4th, 12th, and 24th week after ESWT. Results: Within-group analysis revealed significant improvements in MAS, PROM, TUG Test, and Barthel index for the double-dose ESWT group and improvements in Barthel index for the control group. Between-group analysis revealed greater improvements in TUG Test, Barthel Index and strain elastography for the double-dose ESWT group. Generalized estimating equations analysis indicated that the double-dose ESWT group achieved superior outcomes in the TUG Test, Barthel Index, and strain elastography across various time points and groups. Conclusions: Double-dose ESWT showed better functional improvement and elastography compared to the control group. ESWT demonstrated dose-response effectiveness for PSS of ankle-equinus. Trial registration: NCT05878223. [ABSTRACT FROM AUTHOR]

Background: The relationship between recurrence risk perception, fear of progression, and health behaviors in patients with ischemic stroke is unclear. Objective: To explore the effect of accuracy and level of recurrence risk perception on health behaviors and the mediating role of fear of progression. Methods: We conducted a 2-wave survey. Patients with ischemic stroke (N = 261) were recruited from 2 hospitals in Guangzhou, China. Before discharge, demographic information, objective recurrence risk, perceived recurrence risk, fear of progression, and health behaviors were investigated. After 1 month, the patient's health behaviors were followed up. Results: The median (quartiles 1-3) scores for recurrence risk perception and fear of progression were 43.0 (39.0-46.0) and 22.0 (18.0-28.0), respectively. Only 22.2% of the patients correctly perceived the risk of recurrence, 23.0% underestimated the risk, and 30.7% overestimated the risk. Patients who overestimated the risk of recurrence (β = 0.421, P =.002) or had a higher perceived level of recurrence risk (β = 0.446, P <.001) had a higher fear of progression, which contributed to better health behaviors at 1 month (β = 0.197, P =.001). Fear of progression played a partial and full mediating role, respectively. Patients who underestimated the recurrence risk had worse health behaviors than those who accurately perceived it (β = −0.296, P =.033). Conclusion: Both accuracy and level of recurrence risk perception were independent predictors of future health behaviors, and fear of progression was mediating. Health care professionals should develop individualized risk education programs to help stroke patients properly understand and cope with the risk of recurrence. [ABSTRACT FROM AUTHOR]

Purpose: Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Rehabilitation could help prolong independence, but indicators for timely intervention in this population are lacking. This study aimed to identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease. Method: Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD), recruited from hospital or community services, throughout England. Disability in basic (Barthel Index) and instrumental (Lawton–Brody IADL Scale) ADLs were assessed monthly over six months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined predictors of increasing disability in basic and instrumental ADLs. Findings: Between March 2020 and January 2021, we recruited participants with a diagnosis of NSCLC (n = 110), COPD (n = 72), and ILD (n = 19). 151 participants completed ≥3 timepoints and were included in the longitudinal analysis. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1⋅41 [CI: 1⋅14–1⋅74], p = 0⋅002). Conclusion: Mobility limitation could be used as a simple referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs. IMPLICATION FOR REHABILITATION: To our knowledge this is the first prospective cohort study of trajectories of disability in activities of daily living (ADL) in advanced respiratory disease, including recruitment during the Covid-19 pandemic. It adds to existing evidence by identifying individual variability in trajectories of ADL disability which are undetected at group level. The identification of mobility limitation as a predictor of increasing ADL disability, while controlling for malignant or non-malignant respiratory disease, is novel and has practical utility. Our findings have implications for clinical care, as early identification of functional decline through use of mobility limitation tools could flag early referral to rehabilitation services, potentially preventing or delaying forthcoming functional decline and avoiding reactive crisis management. Mobility limitation is a predictor of increasing disability in activities of daily living in advanced disease, which could be used to flag early referral to rehabilitation services, to help prevent or delay forthcoming functional decline and avoid reactive crisis management [ABSTRACT FROM AUTHOR]

Accessible SummaryWhat is known on the subject?Functioning is one of the most affected areas in schizophrenia. Social, occupational and personal domains are affected, and these deficits are responsible for a major part of the disability associated with the disorder.There are several instruments to measure functioning, but the HoNOS provides a wide assessment of impairment in 12 areas of functioning.What does the paper add to existing knowledge?The Spanish version of the HoNOS shows good properties in terms of reliability and validity for use in schizophrenia patients.Although some authors divide the scale according to proposed underlying dimensions, in schizophrenia this division may not be appropriate.What are the implications for practice?A reliable and easy‐to‐use measure of impairment in different areas of functioning is useful for optimizing the treatment and rehabilitation of patients with schizophrenia. Introduction: The HoNOS scale was designed for the assessment of psychosocial impairment in various domains. While it is widely used in psychiatric settings, it has not been validated in Spanish for use in patients with schizophrenia. Aim: To examine the psychometric properties of the Spanish version of the HoNOS scale in a sample of schizophrenia patients. Method: A total of 194 individuals aged 18 to 65 with schizophrenia spectrum diagnoses were evaluated using the HoNOS. Illness severity and level of functioning were also assessed. Results: The HoNOS showed moderate internal consistency, good inter‐observer reliability and good test‐retest reliability. Factor analysis revealed an internal structure consisting of four factors, with item distribution differing from the theoretical dimensions proposed for the original scale. Discussion: The Spanish version of the HoNOS scale is a reliable and valid instrument for assessing psychosocial impairment in individuals diagnosed with schizophrenia spectrum disorders. However, further research is needed to determine its internal structure more accurately. Implications for Practice: The HoNOS scale provides researchers and clinicians with a valid measure of impairment in twelve different domains, which can facilitate and guide the treatment of schizophrenia patients. [ABSTRACT FROM AUTHOR]

Background: The purpose was to investigate the frequency of lower urinary tract symptoms (LUTS) and lower urinary tract dysfunction (LUTD) in Duchenne muscular dystrophy (DMD) and the relationship between these symptoms and independence and quality of life (QoL). Methods: The cross-sectional study included children aged 5–18 years and diagnosed with DMD and their families. Data were collected using the Dysfunctional Voiding and Incontinence Scoring System (DVISS), the Barthel Index, and the Pediatric Quality of Life™ 3.0 Neuromuscular Module (PedsQL-NMM). Results: The study was completed with 45 children with DMD. LUTS was found in 86.66% and LUTD was found in 44.44%. The most common symptom was holding maneuvers (62.22%). Other common symptoms were urinary urgency (55.55%), daytime urinary incontinence (46.66%), and enuresis (31.11%). There was a significant correlation of the DVISS with the level of independence and QoL (p < 0.05). Moreover, higher LUTS score was associated with lower Barthel and PedsQL-NMM scores. Conclusion: LUTS is a neglected condition, although it is frequently seen in children with DMD. Clinical trial registration: NCT05464446 [ABSTRACT FROM AUTHOR]

Background: Performing activities of daily living comprise an important risk factor for falls among non-bedridden stroke inpatients in rehabilitation departments. Objectives: To explore the correlation between Barthel Index score and the occurrence of falls in non-bedridden stroke rehabilitation inpatients. Methods: In this cross-sectional study, information of patients grouped as non-bedridden patients by the Longshi Scale was collected. Results: A total of 3097 patients were included in this study, with a fall incidence of 10.43%. After adjusting covariates, the total score of Barthel Index and falls in non-bedridden inpatients after stroke presented an inverted U-shaped curve relationship, in which inflection point was 60. The effect sizes on the left and right sides of infection point were 1.02 (95%CI 1.00–1.04) and 0.97 (95%CI 0.96–0.99), respectively. Conclusions: Non-bedridden stroke patients with moderate activities of daily living (ADL) capacity may be at particularly increased risk of falls in rehabilitation departments. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the effects of cat-assisted therapy (Ca-AT) on a patient in their homes, specifically investigating the effects on patient's memory, behavioral pathology and ability to perform activities of daily living, independently. Design/methodology/approach: A case study design was used in patient's homes using three measuring scales, namely, Mini-Mental State Examination (MMSE), Barthel index (BI) and Behavioral Pathology in Alzheimer's Disease (AD) Rating Scale. Findings: The MMSE and BI mean scores were increased, whereas the Behavioral Pathology mean score was decreased. Patient negative behaviors were improved specifically, aggressiveness, anxieties, phobias, and caregiver burden was decreased. Practical implications: Patients with AD could significantly benefit from Ca-AT in their own homes, and it could decrease caregiving burden. Originality/value: Ca-AT is a newly developed type of animal-assisted therapy that uses cats to treat patients, especially elderly people with AD, in their homes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to analyze the association between the degree of frailty and inappropriate prescribing patterns at admission to an Acute Care of the Elderly Unit (ACE Unit). Methods: Prospective observational study conducted in the ACE Unit of an acute hospital in Barcelona city between June and August 2021. Epidemiological and demographic data were collected during hospitalization. Comprehensive geriatric assessment was performed on admitted patients. We recorded frailty (FRAIL scale), extreme polypharmacy (10 or more drugs), central nervous system potentially inappropriate medications‐PIMs (STOPP‐CNS or group D), cardiovascular potential prescribing omissions‐PPOs (START‐CV or group A), and anticholinergic burden using the drug burden index (DBI). Results: Ninety‐three patients were included, of whom 48 (51.6%) were male, with a mean age of 82.83 (SD 7.53) years. The main diagnosis upon admission was heart failure in 34 patients (36.6%). Frail patients were older, with more dependence of activities of daily living and more comorbidity than non‐frail patients. Additionally, frail patients demonstrated more omissions according to the START‐A criteria. No statistically significant differences were observed in term of extreme polypharmacy, PIMs, or anticholinergic burden. Conclusions: In the current study we found an association between frailty and inappropriate prescribing, specifically with regard to omissions using the START criteria for the cardiovascular system (group A). Notably, frail patients exhibited more omissions compared to their non‐frail counterparts, and this difference was statistically significant. [ABSTRACT FROM AUTHOR]

Stroke is a sudden cerebral root neurologic collapse, a major cause for global morbidity and death, necessitates the use of neuroprotectants to prevent further damage to ischemic decline. Citicoline and piracetam are widely used as neuro-protectives, however their benefits in Acute Ischemic Stroke have not yet been established. This prospective, quasi-experimental study compared the effectiveness of citicoline (Group A) and citicoline with piracetam combination (Group B) in moderate-to-severe patients. 75 patients were divided into two groups (25 in Group A and 50 in Group B) and followed for a period of 90 days. Their cognitive and functioning events were examined using National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI). There is no discernible difference (p > 0.05) amongst the two groups by NIHSS whereas, there was a significant difference (p<0.05) in mRS and BI. After 90 days, Group A patients significantly progressed in terms of overall functional and cognitive improvement. The administration of citicoline within the first 24 hours of a stroke helps to prevent further sequelae and minimizes the severity of AIS. This study concludes that citicoline alone responds better than piracetam combination, but its neuroprotective properties have not been proven. [ABSTRACT FROM AUTHOR]

The lack of preparation among carers in providing care for survivors of stroke leads to increased caregiver burden and depression. Studies on trajectory-based support addressing phase-specific needs for essential knowledge and skills to support caregiving preparedness are limited. This randomized controlled trial involved eighty participants from a Chinese tertiary hospital, randomly assigned to an experimental or control group (n = 40 each). The experimental participants received the 9-weeks of five sessions that included informational, emotional, instrumental, and appraisal support combined with trajectory-based support conducted via the WeChat platform. The control group received only usual care. Caregiver burden and depression were assessed at pre-test before the intervention and post-test at the end of the program. Instruments used to collect the data were a demographic questionnaire, the Chinese version of the Zarit Burden Interview, and the Chinese version of the Patient Health Questionnaire-9. Data were analyzed using descriptive statistics, paired and independent t-tests, Mann-Whitney U test, and Wilcoxon Signed Ranks Test. The results indicated that after the program, the experimental group had significantly lower mean scores of caregiver burden and depression compared to before the program and the control group. However, no statistical differences were observed in the control group between pre- and post-test depression scores. These findings suggest that enhancing care preparedness through the trajectory-based support program reduces caregiver burden and depression among carers of people with stroke in China. Therefore, nurses can utilize trajectory-based support via WeChat to alleviate caregiver burden and depression in this population. However, further testing in other settings is necessary before widespread implementation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Caring for neurological patients poses a serious burden on caregivers, even in normal times. It is likely that this burden has become even more painful post-COVID-19 pandemic. OBJECTIVE: This study evaluates the effect of the COVID-19 pandemic on the care burden of those who care for patients with chronic neurological diseases. METHODS: The study included 50 patients and 50 caregivers. All the tests were conducted twice, it was answered firstly, according to the pre-COVID-19 pandemic, and secondly, during the COVID-19 pandemic period. The depression levels of the patients and caregivers were assessed with the Beck Depression Scale, their sleep quality with the Pittsburgh Sleep Quality Index, their quality of life was assessed with the RAND 36-Item Health Survey, and caregivers' burden of care was evaluated with the Zarit Caregiver Burden Scale. RESULTS: It was observed at the end of the study that the depression levels of patients (p = 0.00), and caregivers (p = 0.00) increased post-COVID-19 pandemic, the sleep quality of caregivers (p = 0.00), and patients (p = 0.02) decreased post-COVID-19 pandemic. On the other hand, it was determined that caregivers' burden of care increased (p = 0.00). Sub-parameters of the RAND 36-Item Health Survey, physical functioning (p = 0.02), role limitations due to physical health (p = 0.00), and role limitations due to emotional problems (p = 0.03) decreased for caregivers. CONCLUSION: In summary, we concluded that the well-being and psychological status of both patients and their caregivers were adversely affected by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background and Objectives: Sarcopenia is a significant concern in stroke rehabilitation, with a high prevalence reported in acute stroke patients. This study examines the effect of sarcopenia on rehabilitation outcomes in acute stroke patients. Materials and Methods: This study was conducted with acute stroke patients admitted within 90 days of onset to the rehabilitation hospital. Participants were divided into a stroke with sarcopenia group and a stroke without sarcopenia group. Evaluations were conducted at baseline, 4 weeks, and 8 weeks, including the following assessments: manual muscle testing (MMT), Berg Balance Scale (BBS), functional ambulation category (FAC), and Modified Barthel Index (MBI). Both groups received an identical rehabilitation program for 8 weeks. Results: Significant within-group improvements were observed in both groups across all measures (p < 0.05). However, the stroke with sarcopenia group showed significantly less improvement in MMT, BBS, FAC, and MBI compared to the stroke without sarcopenia group at both 4 and 8 weeks (p < 0.05). Conclusions: These results underscore the significant impact of sarcopenia on functional recovery in stroke patients, despite both groups receiving identical rehabilitation programs. The presence of sarcopenia was a critical predictor of poorer outcomes in muscle strength, balance, ambulation, and activities of daily living. Given these findings, specific rehabilitation strategies targeting sarcopenia are needed to improve recovery in stroke patients. Future research should include larger sample sizes, longer follow-ups, and sarcopenic patient-specific rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background: The prevalence of frailty and activities of daily living (ADL) disability may be higher in high-altitude Andean regions, due to chronic hypoxia, malnutrition, and physical challenges. and their association is relevant. This study aimed to evaluate the association between frailty and ADL disability among older adults residing in the Totos district in Peru during the year 2022. Methods: A cross-sectional study was conducted in Totos district (mean altitude: 3286 m above sea level), located in Ayacucho, Peru, during 2022. A complete census was employed including residents aged 60 and above. The exposure variable was frailty, defined by fulfilling 3 or more criteria of the Fried phenotype. The outcome variable was ADL disability, defined as a score below 95 on the Barthel index. Generalized linear models with a Poisson family, logarithmic link function, and robust variances were employed to estimate crude prevalence ratios and adjusted prevalence ratios (aPRs), along with their corresponding 95% confidence intervals (CIs). Results: We evaluated 272 older adults with a mean age of 74 years, of whom 59.9% were female, 62.1% were cohabiting or married and 83.1% had not completed primary education. We found that 19.5% were frail, while 51.1% had ADL disability. In the adjusted regression model, we found frailty increased the prevalence of ADL disability (aPR = 1.77; 95%CI: 1.44–2.16; p < 0.001). Conclusion: Frailty was associated with an increased prevalence of ADL disability. These findings could contribute to establishing government intervention plans to manage disability and frailty within the high-risk group comprising older adults living at high altitudes. [ABSTRACT FROM AUTHOR]

Purpose: It has reported that the prevalence of frailty in patients with pancreatic cancer is 45%. The number of patients with pancreatic cancer is increasing, and within this cohort, patients often suffer from impaired activities of daily living (ADLs). This study aimed to examine the association between perioperative Barthel Index (BI) scores, a validated measure of ADLs, and survival outcomes after pancreatectomy for pancreatic cancer. Methods: We analyzed the data of 201 patients who underwent pancreatectomy for pancreatic cancer between 2010 and 2020. Preoperative and postoperative ADLs were assessed using the BI (range: 0–100; higher scores indicated greater independence). A preoperative or postoperative BI score ≤ 85 was defined as an impairment of perioperative ADLs. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) after adjusting for potential confounders. Results: Among the 201 patients, 14 (7.0%) had a preoperative BI score ≤ 85 and 50 (25%) had a postoperative BI score ≤ 85. Impairment of perioperative ADLs was independently associated with shorter overall survival (multivariable HR: 2.66, 95% confidence interval [95%CI]: 1.75–4.03, P < 0.001), cancer-specific survival (multivariable HR: 2.64, 95%CI: 1.15–4.25, P < 0.001), and recurrence-free survival (multivariable HR: 1.94, 95%CI: 1.08–3.50, P = 0.021). Conclusion: Impairment of perioperative ADLs is associated with poor prognosis following pancreatectomy for pancreatic cancer. The maintenance and improvement of perioperative ADLs could play an important role in providing favorable long-term outcomes in patients with pancreatic cancer. [ABSTRACT FROM AUTHOR]

Background/Objectives: The objective of this study was to develop a novel quantitative disability assessment tool for patients with idiopathic Parkinson's disease (IPD). Methods: A total of 47 patients with IPD were recruited from two hospitals. A specialist in Rehabilitation Medicine utilized the modified Schwab and England Activities of Daily Living Scale (mSEADL) as a reference, conducting a comprehensive medical chart review and an in-depth interview. The novel-developed disability measurement was calculated as ((mSEADL during the on-state) × (time of on-state)) + ((mSEADL during the off-state) × (time of off-state))/(waking time). Additionally, the degree of disability was assessed using the Korean version of the Modified Barthel Index during the on-state. Results: Twenty-four participants (51.1%) exhibited the off-state during waking hours. In patients exhibiting an off-state, the mSEADL score was significantly lower during the off-state than during the on-state (p < 0.05). The novel-developed disability measurement demonstrated a higher correlation coefficient with the reference mSEADL (0.960) than with the K-MBI (0.808), with statistical significance (p < 0.05). Conclusions: The results demonstrated that larger IPD patients exhibited an on–off phenomenon with greater dependency during the off-state. Therefore, the on–off phenomenon should be considered when evaluating disability in patients with IPD, with methods such as the novel-developed disability measurement tool in this study. [ABSTRACT FROM AUTHOR]

Background: Both pre-or post-COVID-19, older adults residing in nursing homes are at significant risk for social isolation, which is negatively associated with cognitive ability. Currently, the elderly aged 80 years and older are the fastest-growing age group globally. The extent of social isolation within this group post-COVID-19 and its impact on cognitive abilities remain inadequately explored. Objective: This research aimed to evaluate the prevalence of social isolation among the oldest old in Chinese nursing homes post-COVID-19 and to investigate the mediating and moderating roles of basic activities of daily living (BADL), depression, and subjective socioeconomic status in the relationship between social isolation and cognitive ability. Methods: This cross-sectional study included 453 participants aged 80 years and older from 11 nursing homes in Ningbo, Zhejiang Province, China. Social isolation was assessed using the Lubben Social Network Scale-6 (LSNS-6), cognitive ability using the Mini-Mental State Examination (MMSE), BADL using the Barthel Index (BI), and depression using the Patient Health Questionnaire-9 items (PHQ-9). Mediation and moderation effects were statistically analyzed using SPSS 23.0 and PROCESS 3.5. Results: The mean age of the study sample was 87.1 ± 3.8 years, among whom 60.3% (n = 273) were female, and 56.1% experienced social isolation, with 41.1% and 63.1% being isolated from family and friends, respectively. Social isolation indirectly affected cognitive ability through BADL and depression, respectively, and through the chain mediation effect of BADL and depression. Subjective socioeconomic status moderated the relationships between social isolation and BADL and between social isolation and depression. However, no moderating effect of subjective socioeconomic status was found between social isolation and cognitive ability. Conclusion: This study deepens our understanding of the current state of social isolation and its mechanisms of action in the oldest old post-COVID-19 and provides a new basis for future public health policy development and related research. [ABSTRACT FROM AUTHOR]

Background: Stroke patients often experience limb dysfunction, which can significantly impact their quality of life and daily living abilities. This study aimed to explore the effectiveness of nursing programs that incorporate multidisciplinary continuing care with the participation of nursing staff for patients with stroke and limb dysfunction. Methods: This was a randomized controlled trial (RCT) conducted from August 2021 to August 2023. Ninety stroke patients were randomly assigned to a control group (n = 45) and an observation group (n = 45). The control group received routine discharge care, while the observation group received multidisciplinary continuing care with the participation of nursing staff. Outcomes measured included Fugl-Meyer Assessment (FMA) scores for upper and lower limb function, quality of life, daily living ability (Barthel Index, MBI), and adverse reactions. Results: The FMA scores for upper and lower limbs were significantly higher in the observation group compared to the control group. The observation group also had significantly higher scores in all quality of life dimensions and MBI scores compared to the control group. There were 10 adverse reactions reported in the observation group and 22 in the control group. Conclusions: Implementing multidisciplinary continuing care with the participation of nursing staff for stroke patients with limb dysfunction has a positive effect on improving limb function, quality of life, and daily living abilities, while also being relatively safe. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to explore the feasibility of using machine learning approaches to objectively differentiate the mobilization patterns, measured via accelerometer sensors, of patients pre- and post-intervention. Methods: The intervention tested the implementation of a Frailty Care Bundle to improve mobilization, nutrition and cognition in older orthopedic patients. The study recruited 120 participants, a sub-group analysis was undertaken on 113 patients with accelerometer data (57 pre-intervention and 56 post-intervention), the median age was 78 years and the majority were female. Physical activity data from an ankle-worn accelerometer (StepWatch 4) was collected for each patient during their hospital stay. These data contained daily aggregated gait variables. Data preprocessing included the standardization of step counts and feature computation. Subsequently, a binary classification model was trained. A systematic hyperparameter optimization approach was applied, and feature selection was performed. Two classifier models, logistic regression and Random Forest, were investigated and Shapley values were used to explain model predictions. Results: The Random Forest classifier demonstrated an average balanced accuracy of 82.3% (± 1.7%) during training and 74.7% (± 8.2%) for the test set. In comparison, the logistic regression classifier achieved a training accuracy of 79.7% (± 1.9%) and a test accuracy of 77.6% (± 5.5%). The logistic regression model demonstrated less overfitting compared to the Random Forest model and better performance on the hold-out test set. Stride length was consistently chosen as a key feature in all iterations for both models, along with features related to stride velocity, gait speed, and Lyapunov exponent, indicating their significance in the classification. Conclusion: The best performing classifier was able to distinguish between patients pre- and post-intervention with greater than 75% accuracy. The intervention showed a correlation with higher gait speed and reduced stride length. However, the question of whether these alterations are part of an adaptive process that leads to improved outcomes over time remains. [ABSTRACT FROM AUTHOR]

Introduction/objectives: Primary health care visits post-discharge could potentially play an important role in efforts of reducing hospital readmission. Focusing on a single or a particular type of visit obscures nuances in types of primary care contacts over time and fails to quantify the intensity of primary health care visits during the follow-up period. The aim of this study was to explore associations between the number and type of primary health care visits post-discharge and the risk of hospital readmission within 30 days. Methods: A register-based closed cohort study. The study population of 6135 individuals were residents of Stockholm who were discharged home from any of the 3 geriatric inpatient departments, excluding those who were readmitted within the next 24 h. The dependent variable was hospital readmission within 30 days of discharge. The key independent variable was the number and type of primary health care visits in 30 days post-discharge. Cox-regression with time-varying covariates was employed for data analyses. Results: Approximately, 12% of the participants were readmitted to hospital within 30 days. There was no statistically significant association between number of primary care visits post-discharge and readmission (HR 1.00; 95% CI 1.00-1.01). Compared to no primary health care visit, no statistically significant association were found for administrative care related visits (HR 0.33, 95%CI 0.08-1.33), clinic visits (HR 0.93, 95%CI 0.71-1.21), home visits (HR 1.03, 95%CI 0.84-1.27), or team visits (HR 0.76, 95%CI 0.54-1.07). Conclusions: There were no associations between primary health care visits post-discharge and hospital readmission after geriatric inpatient care. Further studies using survey or qualitative approaches can provide insights into the factors that are relevant to post-discharge care but are unavailable in this type of register data studies. [ABSTRACT FROM AUTHOR]

Background: For patients with sepsis receiving non-invasive ventilation (NIV), early rehabilitation is crucial. The Sitting Baduanjin (SBE) is an efficient early rehabilitation exercise suitable for bed patients. There is no consensus about the effect of SBE on the early rehabilitation of septic patients with NIV. This study focused on how the SBE affected the early rehabilitation of sepsis patients with NIV. Methods: 96 sepsis patients with NIV were randomly assigned to either an Baduanjin group that received the SBE based on the routine rehabilitation exercise (n = 48) or a control group (n = 48) that received routine rehabilitation exercise. The primary outcome was the Medical Research Council(MRC)score, and the Barthel Index score, the duration of NIV, length of ICU stay, length of total stay, hospitalization expense as secondary outcomes. Results: A total of 245 sepsis patients were screened, with 96 randomly assigned. The study was completed by 90 patients out of the 96 participants.Results revealed that the MRC score increased in both groups, but the improvement of muscle strength in Baduanjin group was more obvious, with statistical significance (p < 0.001).There was statistically significantly difference between the two groups in Barthel Index at the day of transfer out of ICU(P = 0.028).The patients in the Baduanjin group had an average reduction of 24.09 h in the duration of NIV and 3.35 days in total length of hospital stay compared with the control group (p < 0.05).Of note, the Baduanjin group had significantly reduction the total hospitalization expense. No serious adverse events occurred during the intervention period. Conclusions: In patients with sepsis, the SBE appears to improve muscle strength and activities of daily living (ADL), and lowed the duration of NIV, the length of the total stay, and the hospitalization expense. Trial registration: The study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR1800015011 (28/02/2018). [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONDifferential Item Functioning (DIF), an item malfunctioning, causes Differential Test Functioning (DTF), thus biasing questionnaire measures. The current study evaluates the relationship between DIF and DTF for the Barthel Index and the Functional Independence Measure, likely the most used disability measures. The aim is to understand under which conditions DIF can be ignored as its DTF is negligible.A simulation study was run. Disability measures were obtained for the Barthel Index and FIM motor domain using Rasch analysis with previously published item calibrations. Several DIF scenarios have been assessed. DTF was tolerable if ≤0.50 logits.Simulations showed that the larger the DIF, the larger the DTF and that, keeping the overall DIF constant, the total number of items with DIF does not affect DTF. DIF of the items with the lowest or highest calibrations is the most dangerous. The DIF of central items should be so massive to matter in DTF terms that it is unlikely to happen in practice. The FIM robustness to DIF is better than that of the Barthel Index.The FIM and the Barthel Index show remarkable robustness to DIF. Thanks to this feature, sample invariant, generalisable disability measures are available.The Barthel Index and the Functional Independence Measure are two assessment procedures for evaluating disability.It is demonstrated that the Functional Independence Measure and the Barthel Index are remarkably resistant to Differential Item Functioning.As a result, these questionnaires yield very generalisable disability measures.The Barthel Index and the Functional Independence Measure are two assessment procedures for evaluating disability.It is demonstrated that the Functional Independence Measure and the Barthel Index are remarkably resistant to Differential Item Functioning.As a result, these questionnaires yield very generalisable disability measures. [ABSTRACT FROM AUTHOR]

Purpose: Risk assessment in elder abuse is usually considered an additive process; risk factors are viewed as independent, and the higher the number of risk factors, the higher the risk. This study aims to explore the effect of the interaction between cognitive structures (episodic memory, perceptual speed, verbal fluency, executive function) and functional dependency on elder abuse. Design/methodology/approach: The authors collected data from 62 participants, aged between 64 and 94 years old, in the Minho region of Portugal. Face-to-face interviews were conducted to apply the assessment procedures. Findings: Results showed that emotional abuse is predicted by episodic memory and phonemic fluency, financial abuse by perceptual speed and phonemic fluency and neglect by perceptual speed. Moderation analysis showed that these effects were greater for older adults with higher dependence on movement and lower dependence on hygiene and daily organization. This study supports the hypothesis that the risk of elder abuse is interactive, highlighting a limitation of current risk assessment procedures. Originality/value: The current study explores the possibility of risk factors for elder abuse interacting. Understanding how risk factors interact can help to design more accurate measures of the risk of elder abuse. [ABSTRACT FROM AUTHOR]

Planning an immediate and multidisciplinary rehabilitation is crucial to reduce the significant physical, cognitive, and psychosocial impact resulting from head trauma. This study highlights the importance of ongoing cognitive rehabilitation in conjunction with other rehabilitation therapies, such as motor, occupational, and speech therapy, for a 19-year-old woman who suffered an acquired traumatic brain injury in a high-energy vehicle accident. When the patient was admitted to the hospital, their cognitive functioning (LCF) was 4 (confused-agitated state), their Barthel index was 0, their Glasgow coma scale (GCS) was 7, and their disability rating scale (DRS) was 7. The patient's cognitive functioning improved to LCF 8 (purposeful-appropriate), numerical rating scale: 0/10, Barthel index: 53, GCS:15, and DRS: 5 at the time of discharge from the neurorehabilitation unit. In conclusion, early cognitive intervention in a multidisciplinary rehabilitation program is essential to maximizing the patient's potential and improving the rehabilitation's outcome. [ABSTRACT FROM AUTHOR]